In its ruling this year upholding Obama­care, the U.S. Supreme Court gave states the ability to opt out of a provision to expand Medicaid, which helps provide health insurance to people with low incomes.

In a bow to conservatives, several Republican governors have refused to expand the program. Nevada Gov. Brian Sandoval, a Republican, has yet to announce whether he will seek the expansion of the state’s program.

As Sandoval studies the issue, we hope he sees the clear reasons to expand the program. Medicaid provides access to health insurance for millions of Americans, and expanding it is the moral thing to do. There’s no reason to let people suffer and die with treatable ailments because they can’t get insurance. And covering the uninsured makes good fiscal sense, too, because it would reduce some significant costs.

However, the debate about Medicaid expansion has been muddied by falsehoods and vitriol. For example, there still are complaints about a government “takeover” and “rationing” of health care. (There’s no takeover; the law mandates that people buy private health insurance. And if the critics are concerned about rationing, why aren’t they complaining about the private, for-profit insurance companies that are now making life-and-death decisions in doling out care?)

We also have heard the cries that the expansion will harm health care: With more people insured, there will be competition for health care services. In some corners of Nevada, where the concentration of health care services lags behind other states, there is a worry that adding more people seeking care to an already-stressed system will create a scarcity of services.

It’s odd to hear the conservative critics complaining about competition because they normally see that as a good thing. (It’s the way the free market is supposed to work, isn’t it?) Besides, adding more people creates more demand, and the market will rise up to meet that demand, won’t it?

It should, and that’s one reason Sandoval should pursue expanding Medicaid. It will give the state’s health care system — and the economy — a much-needed boost.

This year, Sandoval called for creating 50,000 jobs, and the expansion of Medicaid presents a great opportunity toward meeting that goal.

Health and medical services play a prominent role in the economic development study issued last year by the Brookings Institution and SRI International. It’s a growth industry that offers good-paying jobs, and expanding Medicaid would help push the economy along.

There are concerns about the state’s cost of expanding Medicaid, but what can’t be overlooked is that taxpayers and people with insurance already are paying for the treatment of the uninsured. And it’s not an insignificant amount. What happens is that those without insurance let ailments linger, which exacerbates their problems. When they seek treatment, they tend to go to hospital emergency rooms with more advanced ailments than if they had seen a primary care doctor. The costs of their hospital care are passed on to taxpayers, who fund public hospitals, and people with insurance, who face higher rates as a result.

Clark County’s public hospital, UMC, is on the hook every year for tens of millions of dollars due to treating uninsured people. Expanding Medicaid would cut down on those expenses as well as alleviate some needless suffering.

The bottom line is that this makes sense, and Sandoval should support the expansion of Medicaid for the health of Nevada, both physically and economically.

Join the Discussion:

Previous Discussion: 11 comments so far…

Comments are moderated by Las Vegas Sun editors. Our goal is not to limit the discussion, but rather to elevate it. Comments should be relevant and contain no abusive language. Comments that are off-topic, vulgar, profane or include personal attacks will be removed. Full comments policy. Additionally, we now display comments from trusted commenters by default. Those wishing to become a trusted commenter need to verify their identity or sign in with Facebook Connect to tie their Facebook account to their Las Vegas Sun account. For more on this change, read our story about how it works and why we did it.

Only trusted comments are displayed on this page. Untrusted comments have expired from this story.

The Sun article starts from a factually skewed perspective. The Supreme Court ruled that Obamacare could not force states to expand Medicaid coverage if the State did not have the financial resources to do so. [Most states now and in the future don't]. Obamacare tied all Federal funds to the States' on the requirement that States expand Medicaid coverage. The Supreme Court ruled, when deciding on Obamacare's constitutionality, that this particular feature was unconstitutional. The Court said the Federal government can't tie current and future Federal funds to expanding Medicaid coverage. Excellent decision to guarantee those in need are not cut off without cause.

The rest of the Medicaid expansion, when it comes to States and their financial resources to do so, goes all downhill from there.

Nevada is second only to Texas in percentage of its population that lacks health insurance. We're already paying for very expensive emergency care through higher insurance premiums and property taxes. It not only makes economic sense to opt in, it's the moral thing to do.

Enjoyed the editorial, LV Sun, but explaining to Governor Sandoval reason is the same as talking to a wall.

The Federal Government now has tools in place to help people with adequate and affordable health care. Available to all States without question.

The State of Nevada has deplorable statistics regarding health care. Just a little over twenty-two percent of Nevadans enjoy little or no adequate health care. Not sure if people in these statistics can qualify for Medicaid, but I'd be willing to bet that participation in this program would bring those numbers down.

This LV Sun article correctly identified the problem: Our useless Governor. Governor Sandoval will continue to drag his feet and...do nothing. Because he is a prisoner of his stupid political party's warped ideals where money trumps people any and every day. Governor Sandoval believes in less Government. Well, except for anyone tries to step forward and tries to raise taxes on mining interests here in Nevada. Because he's in their pockets to run interference.

Governor Sandoval intends to lord over the death camp called Nevada. He won't lift a finger regarding Medicaid. He could care less if people here live or die.

All he cares about are party politics. That's it. Anything else is of no consequence in his world.

For those who believe, and there are many, that President Obama's relection in concert with the Supreme Court decision in June 2012, is the seal of approval for Obamacare as the law of the land, think again. The fate of Obamacare, like it or not, right or wrong, is in the hands of the Governors. Currently, and as a result of a gain in the GOP State Houses nationwide on November 6, 2012, 60 percent of the States have Republican governors. That's 30 States. Twenty four of these 30 States have Republican state legislative majorities.

If you think the President, Reid and Pelosi have the upper hand in the budget negotiations for a grand bargain, ponder this factoid on the fate of Obamacare.

Someway, I tend to think that Governor Brian Sandoval, having been a judge, will carefully weigh this out and make a good decision. There will be no "perfect decisions" as some hope for, so we must settle for "good" here. Based on "...that's one reason Sandoval should pursue expanding Medicaid. It will give the state's health care system -- and the economy -- a much-needed boost.

This year, Sandoval called for creating 50,000 jobs, and the expansion of Medicaid presents a great opportunity toward meeting that goal."

We have a growing need for medical care services with an aging baby boomer population. We need to reform our educational system to gear up to provide qualified health care professions to service the needs of the people. So improving our educational system comes into play here.

What also needs to be addressed, is ENforcing our borders and immigration policies, and streamlining the system for applicants. The USA should only allow those who can have a positive impact in our country. The USA should look at the immigration policies of prospering countries, and take a hint. Our LAWMAKERS need to get with the program, do the d@^n job they were elected to do, and quit "kicking the can down the political road"!

If everyone has insurance, rates go down.

Sure, doctors might actually have to have less golf games, and work a M-F work week like the rest of us. Many doctors these days are taking Mondays, Fridays, and weekends OFF. What's with that??? If you don't happen to fit into THEIR schedule, well, you have the choice of "calling 9-1-1," or "go to the hospital," or "go to an urgent care" provider.

Like a dog with too many "parasites," our society has way too many "parasites" draining the life out of our country and LEGAL citizens. Time to deal with it.

Carmine... Many of the states that have Republican governors and Republican legislatures also have vast numbers of sick indigent uninsured people. How these governors are going to deal with these people in the face of a hospital crisis in which nearly every major hospital in the United States is suffering due to uncompensated care remains to be seen. About half the people in the United States suffer chronic disease. These people are going to have to be dealt with one way or another. If they don't like Obamacare they better come up with something else quick.

Actually the federal government would have enough money to cover these changes if they could crack down on the annual $200 to $300 BILLION in fraud, theft and "billing errors" so prevalent with medicare / medicaid.The feds prefer to ignore those problems and brag about the low "administrative costs" of both programs. Of course their low if you lack sufficient over sight and execution of existing programs.

"In 2010, 36 percent of immigrant-headed households used at least one major welfare program (primarily food assistance and Medicaid) compared to 23 percent of native households," summarizes the document which was published by the Center for Immigration Studies and examines a wide variety of topics relating to immigration.The document breaks down the immigrant families by country of origin and gives specific types of welfare and percentages of the families that used it in 2010. An average fewer than 23 percent of native households use some type of "welfare" which is specifically defined in the study. 36 percent of households headed by immigrants use some type of welfare. Families headed by immigrants from specific countries or areas of the world range from just over 6 percent for those immigrants from Great Britain to more than 57 percent of those from Mexico using some type of welfare. (www.cis.org)

One thing that is missing from the article is that there are approximately 70,000 Nevadans who would qualify for Medicaid right now that are not enrolled for whatever reason. Insuring them does not require raising the limit to 133% because they qualify under todays guideline.

Raising the limit to 133% will have long term effects that Nevadans cannot absorb. Yes, initially the federal gov't pays 100% of the Medicaid cost but that gets reduced to 95% and then to 90% and Nevadans will have to pick up the difference. Ask yourself - with no state income tax, a free public education system (where I come from there were annual registration fees for each student), property taxes at all time lows, one of the highest unemployment rates in the country and businesses going to be hit hard by new taxes and fees due to this bill - can we really afford to expand Medicaid?

What the article also fails to include is the fact that persons who are between 100% and 400% of the federal poverty level (FDL) will qualify for a subsidy. The closer you are to the FDL, the higher the subsidy, so if you are at 105% you'll get a bigger subsidy than someone at 400%. We as taxpayers will be contributing to this subsidy as well.

When 2014 hits and employer groups see the taxes they'll be incurring and end up passing it on to the employee, we're all going to feel it.

If the government had been more focused on creating REAL jobs, not minimum wage jobs, over the past four years then maybe Nevadans would have employer sponsored care and we'd not be talking about the need to expand Medicaid.

WRT the comments about caring for the sick and the Church's teachings, it's an excellent point. I struggle with it myself and always have. I wish there was an answer but sadly, there is not. It comes down to dollars and cents. The reality is there isn't enough if we taxed everybody 100 percent at the State levels to pay for it [expansion of Medicaid to allow free access to healthcare for all in need]. In part, because the government's healthcare standards for the poor are more generous than what most of us who pay for healthcare, can afford.

"We're already paying for very expensive emergency care through higher insurance premiums and property taxes. It not only makes economic sense to opt in, it's the moral thing to do."-----------Alas, the Nevada republican libertarian Teahead types could care less about making economic sense, you can t discuss serious issues with ignorant and vicious idiots..

BobRealist has a point. My sister works in the ER of a major teaching hospital in a southern state. She told me a story of a woman who brought her nine (you read that right) grandchildren to the ER with minor complaints. When asked which one she wanted seen, she said "All of them." She had no insurance.

As far as nez212's comment about the "parasite class", I can only conclude that he has never had a condition that will cost his health insurance company any significant sum of money. If you dare to pull money out of their pockets, they either deny you coverage entirely, jack up your premiums to the point that you can no longer afford them or cancel your coverage. Private insurers are the real "death panels".

Granted, Obamacare is a disaster in the making, but it's pretty clear that the majority of Americans want some sort of affordable healthcare made available to all and that's there's no Constitutional prohibition against such being mandated by the Federal government. And it seems pretty clear we're going to pay, one way or the other, with the only question being how many middlemen and special interests manage to get their hands on a cut of the pie.

Statistically, we know how much is spent on average for various age groups. And we also know that certain lifestyle choices add to risk. How about expanding Medicare, in conjunction with significant tort reform, along the lines of covering non-elective medical services above $5000 annually for each American, waived for <18 and >70. The $5000 would be the responsibility of the individual or State, and could be covered by personal savings or a loan, a tax free medical savings account, private insurance, or State assistance (with whatever loan, workfare or welfare requirements they may have). Basically, the Feds would cover catastrophic care for all, plus the young and the old and the truly helpless. And it'd be paid for by the standard medicare tax plus a hefty sales tax on alcohol, tobacco, marijuana, and "processed" foods (in the belief that obesity & substance abuse are the primary culprits behind most medical problems, and that a sales tax component insures that everyone contributes).

I think those revenue streams would need to be fenced off from the general treasury, with a set percentage allocated for administrative costs. Not enough money, the direct taxes go up. Too much, and the direct taxes go down. Program could be implemented on a state by state basis to allow for close coordination, but program spcifics (i.e. what's to be covered) would be set at the Federal level, largely covering only non-elective procedures and focusing on preventive care for the young and end-of life care for the old.

Not perfect I know, but an idea that's probably more workable than Obamacare will turn out to be. Fraud, waste & abuse will need to be addressed, especially by those who make no personal effort to carry themselves or at least try to follow a healthy lifestyle AND by the hucksters who'll try to milk the system like thay have been, but those may be efforts better addressed at an almost individual level (by tracking SSN and EIN numbers to see who's really costing money and who's taking it in).

@Future:Anyone making $88,000 a year does NOT qualify for ANYTHING free. Where did you get THAT figure? Pull it out of your, ah....head?

@Bob_Realist: MOST people on Medicaid are the elderly, disabled and poor. Where would they get the money to pay back the taxpayers.

@NLV-Indep13:$5000 would be one hefty sum for ANYONE to come up with, especially those who are already struggling financially. These people, or anyone for that matter, would just forego visiting a doctor for any reason. Could you afford a $5000 "deductible"?

@stopthebs:You are SOOO right about the fraud in Medicare and Medicaid. IF the Feds spent more time and money on investigating fraud in both programs - but hey, we know that's NOT going to happen!

Here is a staggering Medicaid figure - here in just Illinois, in the years 2009 and 2010 - 53% of children born were to Medicaid Mothers; of that 53%, most were single and teen moms. I'm curious to see what other States shell out for these Medicaid births. And people complain about the provision in the Affordable Care Act about providing free contraception to those who ask for it, or need it.